Excess Androgens, Congenital Disorders and Male Hypogonadism Flashcards
What is hirsutism?
Excess hair in a male pattern, in a woman
What causes hirsutism?
Excess androgens at the hair follicle
Give 4 causes of hirsutism which present with a long history, fairly normal testosterone and no virilisation?
PCOS, familial, idiopathic, non-classical CAH
How does hirsutism as a result of an adrenal or ovarian tumour present?
Short history with virilisation
What is non-classical CAH?
A partial 21 alpha hydroxylase deficiency which presents in adolescence
How may non-classical CAH present?
Hirsutism, menstrual irregularity, infertility
What treatment is used in non classical CAH?
Low dose corticosteroid
What are the testosterone levels in an androgen secreting tumour?
High (>5)
Which out of adrenal and ovarian androgen secreting tumours are more likely to be malignant?
Adrenal
XO is what condition? Which sex does this affect?
Turner’s syndrome, only affects girls
What are some features of Turner’s syndrome?
Short stature, webbed neck, wide spaced nipples, lymphedema, delayed puberty
What should be screened for in an individual with Turner’s syndrome?
Cardiac and renal problems, IBD, osteoporosis and scoliosis
What cardiac problems may Turner’s cause?
Coarctation of the aorta, bicuspid aortic valve, hypo plastic left heart
What is XX gonadal dysgenesis?
Absent ovaries but no chromosomal abnormalities
What is testicular feminisation?
Androgen insensitivity syndrome: genetically XY but phenotypically female
When is a hysteroscopy performed?
Only in cases where there is suspected or known endometrial pathology
What is the main investigation for pelvic disease?
Pelvic ultrasound
What are the levels of testosterone and LH/FSH in primary hypogonadism?
Testosterone- low, LH/FSH- high
What is the most common congenital form of hypogonadism in males?
Kleinfelter’s syndrome
What is the chromosomal abnormality in Kleinfelter’s syndrome?
XXY
What are some symptoms of Kleinfelter’s syndrome?
Decreased testicular volume, gynaecomastia, intellectual dysfunction, azoospermia
Are people with Kleinfelter’s syndrome fertile?
No
In Kleinfelter’s syndrome, what are the levels of testosterone, LH/FSH, SHBG, oestrogen?
Testosterone- low, everything else high
What are the levels of testosterone and LH/FSH in secondary hypogonadism?
Testosterone- low, LH/FSH- inappropriately low
What is the main cause of secondary hypogonadism in males?
Hypothalamic/pituitary disease
What are some congenital/acquired causes of secondary hypogonadism in males?
IHH, Kallmann’s, CAH
When is testosterone replacement therapy used in hypogonadism?
In young men (< 50)
Does testosterone cause prostate cancer?
No, but it can exacerbate it if it is already there
Will testosterone therapy restore fertility?
No
What may testosterone therapy help with?
Improved sexual function, bone health, body composition, insulin sensitivity, QOL and cognition
Gynaecomastia is a result of an increase in what hormone?
Oestrogen
What are some drugs which may cause gynaecomastia?
Oestrogen, testosteron, digoxin, spironolactone
